What is the ADvantage waiver?
The ADvantage waiver is Oklahoma's main SoonerCare home and community-based services (HCBS) waiver for older adults and adults with physical disabilities. It is a federal Section 1915(c) waiver that lets the Oklahoma Health Care Authority (OHCA) pay for services that help people who would otherwise need a nursing home live at home or in the community instead. Oklahoma Human Services (OKDHS) says the program "promotes individual choice and self-direction."
Not Medicare Advantage. The ADvantage waiver is part of SoonerCare (Medicaid). Medicare Advantage is a private Medicare health plan. They are different programs with different rules, and having one doesn't sign you up for the other.
Who runs the ADvantage waiver?
Two state agencies share the work, under the rules in Oklahoma Administrative Code 317:35-17:
- OHCA, Oklahoma's Medicaid agency, holds the waiver with CMS and writes the rules.
- Oklahoma Human Services Community Living, Aging and Protective Services (CAP) manages the waiver slots and the waiting list, takes applications through its Medicaid Services Unit, and has its nurses decide whether you meet the medical level of care.
- Your county OKDHS office decides whether you qualify financially for SoonerCare.
- ADvantage Administration approves your service plan, which is the last step in program eligibility.
What services does ADvantage cover?
OKDHS and OHCA list these services, provided as your approved service plan allows:
- Case management, including transitional case management when you leave a facility
- Personal care, and advanced supportive or restorative assistance
- Skilled nursing at home
- Adult day health care
- Respite for family caregivers, in the home or in a nursing facility
- Home-delivered meals
- Environmental modifications to your home, specialized medical equipment and supplies, and assistive technology
- Physical, occupational, speech and respiratory therapy
- A Personal Emergency Response System and remote supports
- Prescription drugs that are medically necessary, within the waiver's limits
- Assisted living, but only in a facility that is an ADvantage assisted living center
With Consumer Directed Personal Assistance Services and Supports (CD-PASS), you can hire and direct your own personal care workers instead of using an agency.
Who qualifies?
Under OAC 317:35-17-3 and OKDHS's program page, you must:
- Be 65 or older, or 19 to 64 with a physical disability, or 19 to 64 with a developmental disability if you don't have an intellectual disability or a cognitive impairment related to it.
- Qualify financially for SoonerCare. Monthly countable income must be at or below 300 percent of the SSI federal benefit rate, the same standard as nursing home care (OKDHS Appendix C-1, Schedule VIII.B). Resource limits apply, and spousal rules protect some income and resources for a husband or wife at home (Schedule XI).
- Meet the nursing facility level of care, as an OKDHS nurse determines.
- Need at least one waiver service every month to avoid going into an institution.
- Live in an eligible setting, such as your own home, a family member's home or an ADvantage assisted living center, with needs that waiver services plus family or community supports can safely meet.
The rules also say no one can enroll in ADvantage only to get Medicaid eligibility.
Slots and the waiting list
CMS authorizes a set number of ADvantage slots each year. To be certified, you need an open slot. If CAP determines that all slots are filled, your name goes on a waiting list for entry when a slot opens (OAC 317:35-17-3). The rules on applications (OAC 317:35-17-4) say waitlist procedures start when the waiver reaches the maximum number it authorizes. Whether there is a wait depends on slots at the time you apply, so ask when you call.
How do I apply?
- Pick providers. OKDHS asks you to use its Provider Search tool to choose a home care provider and a case management provider in your county before you apply. You'll need those names for the medical assessment call.
- Apply online or by phone. Complete the online application linked from the OKDHS ADvantage services page. If you can't apply online, call the Medicaid Services Unit at 1-800-435-4711 to schedule a telephone application.
- Complete the SoonerCare financial application. If you don't already have an active SoonerCare case, your county OKDHS office needs a signed medical assistance application and proof of income and resources.
- Have your level-of-care assessment. An OKDHS nurse assesses whether you need a nursing facility level of care.
- Approve your service plan. Your case manager builds a service plan with you, and ADvantage Administration approves it before services start.
Tip: Living in a nursing home now? Oklahoma's Living Choice program, run by OHCA, helps people who have lived in a nursing home for at least 60 days move back to the community, with services for up to a year. Near the end of that year, an ADvantage application is submitted for you.
How ADvantage fits with Medicare
- Medicare stays your health coverage. Doctor visits, hospital stays, short skilled nursing stays and prescriptions still go through Medicare first. ADvantage adds long-term services Medicare doesn't cover, such as ongoing personal care.
- Your drugs come from Part D. Once you have SoonerCare, you get Extra Help automatically. In 2026 that keeps Part D copays to no more than $5.10 for a generic and $12.65 for a brand-name drug.
- Your Medicare premiums may be paid. SoonerCare can pay your Part B premium ($202.90 a month in 2026). OKDHS also checks separately whether you qualify as a QMBP or SLMB, without another application (OAC 317:35-15-1).
- You are not moved into SoonerSelect. OHCA keeps people in a 1915(c) waiver and dual eligibles out of SoonerSelect managed care.
- D-SNPs coordinate, but don't replace ADvantage. A dual eligible special needs plan covers your Medicare benefits and must coordinate with SoonerCare. Your ADvantage services, case manager and providers still come through SoonerCare. Before joining, ask the plan how it works with your ADvantage case manager.
- PACE is another path. If you're 55 or older, need a nursing home level of care and live in a PACE service area, PACE combines Medicare and SoonerCare care in one program. OKDHS lists four PACE centers in Oklahoma, in Tahlequah, Tulsa, Oklahoma City and Shawnee; OHCA answers PACE questions at (405) 522-7044.
To compare Medicare plans from the companies they work with, and check how one would work with your ADvantage services, you can request a call from a licensed insurance agent. Benefits Life is not connected with OHCA or OKDHS, which decide ADvantage eligibility. See also SoonerCare and Medicare, D-SNPs in Oklahoma and helping a parent with Medicare.
Sources
- Oklahoma Human Services — ADvantage Waiver (eligibility, services, how to apply)
- Oklahoma Human Services — Oklahoma Aging and Disability Programs (updated 11-25-2025)
- OHCA — OAC 317:35-17-3, ADvantage program services (revised 09-01-26)
- OHCA — OAC 317:35-17-4, Application for ADvantage services (revised 09-01-26)
- OHCA — ADvantage Waiver Program
- OKDHS — Appendix C-1, Schedules VIII and XI (7/1/2026)
- OHCA — OAC 317:35-15-1, long-term care and QMBP/SLMB
- OHCA — SoonerSelect choice counseling FAQs (excluded groups)
- Medicare.gov — Help with drug costs (Extra Help)
Frequently asked questions
Is the ADvantage waiver the same as Medicare Advantage?
No. The names sound alike, but the ADvantage waiver is an Oklahoma SoonerCare (Medicaid) program for long-term care at home. Medicare Advantage is a private Medicare health plan that replaces Original Medicare. You can have both: Medicare stays your health coverage, and the ADvantage waiver adds home and community services Medicare doesn't pay for.
Who qualifies for the ADvantage waiver in Oklahoma?
You must qualify financially for SoonerCare, meet the medical nursing facility level of care, and be 65 or older, or 19 to 64 with a physical disability (or a developmental disability without an intellectual disability or related cognitive impairment). You must need at least one waiver service every month to avoid a nursing home, and your needs must be safely met with waiver services plus family or community supports.
How do I apply for the ADvantage waiver?
Oklahoma Human Services asks you to pick home care and case management providers in your county with its Provider Search tool, then complete the online application linked from its ADvantage services page. If you can't apply online, call the Medicaid Services Unit at 1-800-435-4711 for a telephone application.
Is there a waiting list for the ADvantage waiver?
The waiver has a set number of slots authorized by CMS. Under OAC 317:35-17-3, when Oklahoma Human Services Community Living, Aging and Protective Services (CAP) finds all slots are filled, new applicants are placed on a waiting list for entry when a slot opens. Ask the Medicaid Services Unit whether slots are open when you apply.
What is the income limit for the ADvantage waiver?
ADvantage uses the same income limit as SoonerCare nursing home care: monthly countable income at or below 300 percent of the SSI federal benefit rate, as listed in OKDHS Appendix C-1, Schedule VIII.B. People with higher income may qualify using a Medicaid Income Pension Trust. Resource limits and spousal rules also apply.
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